- Public Consulting Group (Harrisburg, PA)
- …+ Third Party Administrator Services + Enhance Health and Public Safety Services + Claims Processing Services and Solutions + Consulting and Advisory Services + ... Cost Allocation Plans and Time Studies + Cost Settlement and Supplemental Payment Strategies + Healthcare Access and Markets **Duties and Responsibilities** + Responsible for helping program recipients, family members, and caretakers navigate healthcare… more
- IQVIA (Wayne, PA)
- …Prior healthcare data experience, including working knowledge of physician and patient claims ; IQVIA data preferred. + Prior working experience in Customer: Journey, ... SAS, SQL, R, Python, and/or Excel VBA. + Exposure to cloud processing environments such as Cloudera, Snowflake, and/or Databricks. + Experienced with developing… more
- Guthrie (Troy, PA)
- …contractual reimbursement requirements and to assist in ensuring generation of clean claims in a timely manner + Securing authorization as appropriate + Documenting ... preferred. Knowledge of computer applications (such as Microsoft word processing and spreadsheets) desirable Education/License Current LPN licensure or eligibility… more
- Walgreens (Levittown, PA)
- …enhancements to pharmacy systems to further promote productivity. + Ensures the accurate processing of insurance claims to resolve customer issues and prevent ... payment rejections. Follows-up with insurance companies as well as medical providers and participates in 3rd party audit. + Follows-up with medical providers' offices to clarify prescribed medications, dosages, refills, interactions and allergies to suggest… more
- Takeda Pharmaceuticals (Exton, PA)
- …Oncology brands by integrating pharma commercial datasets including IQVIA Claims , Customer (Healthcare Professionals, Healthcare Organization, Payers and Patients), ... and product teams (Model N) to support pharmaceutical contracting, chargeback/rebate processing and price reporting operations; partner with Model N product team… more
- UPMC (Pittsburgh, PA)
- …ICD-10-CM, CPT, and HCPCS codes to ensure consistency and efficiency in claims processing , data collection, and quality reporting. . **Regulatory Compliance:** ... Conduct audits on various compliance topics to evaluate adherence to state and federal laws, regulations, and policies. . **Reporting:** Prepare written reports of audit results, including recommendations for improvement and compliance with state and federal… more
- Highmark Health (Pittsburgh, PA)
- …operations across all aspects of the Medicaid business, including member enrollment, claims processing , care management, and quality improvement. Implement best ... practices to streamline processes, reduce administrative costs, and enhance the member experience. + **Provider Network Management:** Develop and maintain a high-quality provider network that meets the needs of Medicaid members. Negotiate contracts with… more
- Lake Erie College of Osteopathic Medicine (Erie, PA)
- …received by the patient clinic with an understanding of dealing with and processing Florida Medicaid and Medicare; + Possess a strong sense of patient advocacy, ... responsibility for protocols that will aid patients in the reimbursement of insurance claims ; + Assist in the recruitment, interviewing, and hiring of faculty and… more
- Guardian Life (Harrisburg, PA)
- …logs. + Deliver solutions that enhance underwriting risk assessment, claims auto-adjudication, and customer servicing. Operational Excellence + Establish scalable ... deep learning models including Large Language Models (LLM) and Natural Language Processing (NLP) + Hands-on experience with GPU, distributed computing and applying… more
- Highmark Health (Pittsburgh, PA)
- …review, assisting in navigating a complex regulatory environment, working with claims data, performing financial analyses, and supporting the presentation of ... skills, as well as, proficiency in the use of computer-based data processing + Microsoft Office products, and database applications + Pharmacy license… more